My Congressmen do not represent me or the majority of their constituents. Yes, we can vote them out in 2010 and 2012 (and we will if they continue). If the DNC cares about keeping control of Congress, they'd better be careful about forcing this issue.

It is crazy when our Country desperately needs health care reform, and as it is carried out in the political carnival hallways of mirrors, reform turns into deform. . .

1) We will cut payments to private Medicare Advantage plans
2) Nothing in this bill will require you to change your insurance if you like it

Clearly, if we cut payments to private Medicare Advantage plans, private insurers will either cut benefits, require more in premiums, or will decide to get out of the MA business all-together (thus forcing their customers to lose their current insurance). The reverse effect (when subsidies were increased) was noted by the CBO: http://www.cbo.gov/ftpdocs/79xx/doc7994/04-11-M…

In 2004, Medicare Advantage plans accounted for 13 percent of enrollment in Medicare, the lowest level since 1996. Over the past two years, however, enrollment in those health plans has increased to about 19 percent of all enrollment, or 8.3 million beneficiaries. That increase resulted from changes enacted in the Medicare Modernization Act that increased payment rates and added the prescription drug benefit to complement the medical benefits provided under Parts A and B of Medicare. CBO projects that enrollment in Medicare health plans will continue to increase rapidly in coming years, to 22 percent of total Medicare enrollment in 2008 and 26 percent by 2017 (see Figure 1).

So if MA plans became more attractive when subsidies increased, when those subsidies decrease, how can you argue that those plans will remain as they are now?

This ties into the argument about who is spinning. I would agree that most of the “far out there” rhetoric is coming from the right these days (with the notable exception of the most prominent hitler poster, which is actually a product of a left-wing group). But that fits the pattern as I see it: the party out of power has little to lose and a lot to gain from promoting conspiracy theories and general public unrest. The party in power tries to keep people calm (except to promote some fear of what might happen if they should lose power) and pretend it has got all of its t's crossed. That was true when Bush was in office also. Both sides spin, but in different ways. And no, it doesn't mean both sides are equally wrong–just that the spinners are wrong (the question of which side of spinners is more wrong is unrelated to which side of the genuine argument is more wrong).

Ordinarysparrow, pls. let me know if this answers your questiom

Dorian

There are many many factors involved but the usual reason for futile care is either the doctors, patients or families cannot bear to say “enough”. Within that are many varied and strongly held beliefs depending on training, culture and family dynamics. Since those opinions are so disparate and strong I believe the only way to reduce costs in this area is by government mandate, ie decisions made based on actuarial and financial evidence. This is one area I think countries with nationalized health care do better than the US, mainly out of budgetary necessity. I don't think better education on the topic will help for generations, if ever.

Neither party is set up to take this on right now. The GOP has made the completely ridiculous claims of death panels. The Democrats have made some little peeps about studying “what works and what doesn't” but haven't dared to confront the issue of end-of-life care directly. I think the US is not ready to talk about what amounts to rationing, although it certainly needs to.

It's kind of comforting, in a way. Whatever happens is alright, because everyone is off-base and everyone has a point.

If any of the readers have an idea, please jump in, but as OS says “without turning it into a death panel rhetoric”

It may take me a while, and /or it may come in the form of a post

Dorian

I would not bring this subject up except would like to hear what Dorian, DaGoat or anyone that can speak to it without turning it into death panel scare rhetoric. But is it possible to address the issue of financial reform without speaking of where the largest cost reside?

You make a very good point that both sides are playing political games at the expense of the people. R's want to knock the D's down using obstructionism and hyperbole, thinking it will help them in 2010. The D's, understanding they will probably lose seats in an off year election, want to ram through as much as possible while they have the votes, including those parts that are ill conceived, and additionally want this wrapped up in '09 to minimize it as an election issue going into the 2010 elections.

When you say that this is “the norm for DC”, you hit exactly right, I think.

“The people who like Medicare Advantage will be SOL under Obama's plan. Now you may say “too bad, it's too expensive”, but most politicians don't have the guts to come out and say that“”

Thanks, DG.

No, I don't think I would say that. However—and, again, if I understand Medicare Advnatage correctly—
it seems to me that those on that program have been having a “somewhat free ride.” (At least to the tune of the aforementioned Medicare participants' and other taxpayers' contributions) , and while , as the Times says, “the value of an enrollee’s added benefits would shrink by more than half from current levels [they] would not disappear; they would still be worth about $500 a year in 2019.”

Perhaps we all need to tighten our belts a little bit to make healthcare a little more available to all Americans (Oh, there's that terrible liberal [Socialist?] thought).

To bad politicians from both sides and sit down for a moment, put the rhetoric and partisanship and the thousand page plus proposals aside an think about the areas that there are less disagreement on, patch up those differences in a civil manner and them move on to the areas with the next least amount of disagreement and proceed in the same manner.

They are simply wasting time in getting the less controversial items done and implemented for the American people.

Your average american simply doesn't have much of a clue. They are informed by their favorite news source that specialize in reaffirming their viewers' belief systems.

No you're interpreting it correctly. Here's the thing – Medicare Advantage is a bad deal for the government and most taxpayers, but for many people with Medicare Advantage it's a pretty good deal. For those people they stand to lose something they currently enjoy.

For people on certain medications, who want certain benefits such as dental or routine physicals, people who want to just pay a co-pay, etc Medicare Advantage gives them something Traditional Medicare does not. Now if you've ever heard one of Obama's town halls he always makes the point no one will have to change their current insurance under his plan (whatever that is) and that Medicare Advantage just covers things Medicare already covers. Both of those points are untrue.

The people who like Medicare Advantage will be SOL under Obama's plan. Now you may say “too bad, it's too expensive”, but most politicians don't have the guts to come out and say that.

Correct me if I am wrong, JD, but I don't believe that either or I or the Times have any problem with you wanting your representatives to vote against “it.” I also do not believe that the NY Times has explicitly or implicitly said that it wants Congress to ignore their constituents,

But, I could be wrong…

Cliff's Notes:
Force Americans to take healthcare reform that “overwhelmingly benefits Americans, even if they don't believe it, and even if they want their elected representatives to vote against it.

Well pardon me for wanting MY representatives to vote against it. The majority of their constituents agree. The NY Times wants Congress to ignore their constituents?

That's why the liberal media is going bankrupt.

With respect to ypour comment,

“The NYT article seems pretty reasonable, and it does point out two areas where I think the GOP has a point. Obama has often characterized Medicare Advantage as paying extra to do what Medicare already does. Clearly that is inaccurate – Medicare does not cover the additional benefits offered by Medicare Advantage. Now if Obama wants to say that Medicare Advantage is overpriced and not worth it, that would be an honest assessment. Still, the bottom line is the people who lose Medicare Advantage would lose some benefits they may like.”.

I don't know if I quite understand what you mean by “Medicare does not cover the additional benefits offered by Medicare Advantage.”

As the Times editorial reports, “it is unfair to force those enrolled in traditional Medicare to help foot the bill — currently $43 a year extra for each participant — to help subsidize the private plans. Federal taxpayers have contributed heavily as well.”

Reading this seems to say to me that those who are enrolled in “traditional Medicare” are footing part of the Medicare Advantage biil at the tune of $43 per year per participant, in addition to federal taxpayers contributing to is as well?? Am I interpreting this wrong?

Nor can they match your deep humility .

The NYT article seems pretty reasonable, and it does point out two areas where I think the GOP has a point. Obama has often characterized Medicare Advantage as paying extra to do what Medicare already does. Clearly that is inaccurate – Medicare does not cover the additional benefits offered by Medicare Advantage. Now if Obama wants to say that Medicare Advantage is overpriced and not worth it, that would be an honest assessment. Still, the bottom line is the people who lose Medicare Advantage would lose some benefits they may like.

The other point is the payments to hospitals and providers, plus nursing homes, which nobody ever seems to mention. While it's popular to characterize hospitals as greedy and rich, I can assure you in rural areas this is not the case. Cuts to rural hospitals and nursing homes will mean closures, that 's the reality. In the case of nursing homes, we're talking about caring for the most helpless patients with the least voice in this process. And despite what Green Dreams likes to say, there is not much affection for Medicare among doctors right now, let alone if payments are cut.

I do think the GOP has been mainly obstructive and not very constructive, but there still are some legitimate concerns as the NYT points out.